442 HAS HOSPITAL VARIATION IN THE PROBABILITY OF RECEIVING TREATMENT WITH CURATIVE INTENT FOR ESOPHAGEAL AND GASTRIC CANCER DECREASED OVER TIME?. (14th September 2020)

• Record Type: Journal Article
• Authors: Luijten, J; Vissers, P; Lingsma, H; van Leeuwen, N; Rozema, T; Siersema, P; Rosman, C; van Laarhoven, H; Lemmens, V; Nieuwenhuijzen, G; Verhoeven, R
• Is Part Of: Diseases of the esophagus. Volume 33(2020)Supplement 1
• Publication Date: 2020-09-14
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doaa087.111
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: : Geographical variation in cancer care has been observed between and within countries. Variation in treatment may occur at any point along the cancer care continuum attributing to potentially avoidable disparities in patient outcomes such as survival. Other studies have shown a large variation in the proportion of patients undergoing treatment with curative intent for esophageal(EC) and gastric cancer(GC). Due to these studies and thus an increased awareness, we hypothesize that variation has decreased over time. Methods: Patients with potentially curable EC (n = 10, 115) or GC (n = 3, 983) diagnosed between 2012-2017 were selected from the Netherlands Cancer Registry. Multilevel multivariable logistic regression was used to examine the differences in the probability of treatment with curative intent between hospitals of diagnosis, comparing 2012-2014 with 2015-2017. We compared relative survival (RS) and relative excess risk of death (RER) between hospitals with different probabilities of treatment with curative intent. Results: The range of proportions of patients undergoing treatment with curative intent per hospital of diagnosis was 45-95% in 2012-2014 and 54-89% in 2015-2017 for EC, and 52-100% and 45-100% for GC. The adjusted variation declined for EC with Odds Ratios (ORs) ranging from 0.50 to 1.72 between hospitals in the first period to 0.70–1.44 in the second period (p < 0.001) and did not change for GC (ORs ranging from 0.78–1.23 to 0.82–1.23, p = 1.00). A higher probability of receiving treatment with curative intent was associated with better RS and reduced RER for both types of cancer. Conclusion: Although substantial variation between hospitals of diagnosis in the probability in receiving treatment with curative intent still exists for both malignancies, it has decreased for EC, but did not change for GC. A low probability of receiving curative treatment was associated with a worse survival. Further research is needed to elucidate the factors associated with the observed variability.